Ectopia lentis(EL),characterised by impaired zonular fibers originating from non-pigmented ciliary epithelial cells(NPCEC),presents formidable surgical complexities and potential risks of visual impairment.Cataract su...Ectopia lentis(EL),characterised by impaired zonular fibers originating from non-pigmented ciliary epithelial cells(NPCEC),presents formidable surgical complexities and potential risks of visual impairment.Cataract surgery is the only treatment method for EL,but it leads to the loss of accommodative power of the lens post-operatively.Furthermore,the challenge of repairing zonular ligaments in situ remains a significant global issue.Ocular tissue and aqueous humour samples from patients with EL were subjected to RNA sequencing and Olink high-throughput proteomic analysis,revealing the downregulation of pathogenic genes(FBN1,MFAP2)and upregulation of secretory proteins(IL-12,MMP-1).The high expression of FBN1 and MFAP2 in NPCECs suggests their potential as candidates for zonular fiber construction;however,the limited availability of donor sources restricts the feasibility of NPCEC transplantation therapy.The reprogramming and directional differentiation of induced pluripotent stem cells(iPSC)to NPCEC was successfully achieved using the developed biomimetic scaffolds that mimic the microstructures of natural radial zonular fibers.Excitingly,the single injection of induced NPCEC-like cells significantly contributed to restoring and enhancing mechanical properties in zonular fiber structures in a rabbit model with EL.This proposed in situ iPSC-based regeneration technique might serve as an innovative therapeutic strategy for clinical EL patients,reduce the cataract surgery rate,and retain the adjustment capacity of inherent lentis.展开更多
Background:To evaluate the efficacy and safety of placing dual capsular tension rings for the combined management of traumatic cyclodialysis cleft and zonular dialysis.Methods:A modified capsular tension ring was inse...Background:To evaluate the efficacy and safety of placing dual capsular tension rings for the combined management of traumatic cyclodialysis cleft and zonular dialysis.Methods:A modified capsular tension ring was inserted into the ciliary sulcus and a capsular tension ring or modified capsular tension ring was inserted into the capsular bag in 20 eyes in 20 consecutive patients showing signs of ocular hypotony and ectopia lentis.Outcome measures included intraocular pressure,best-corrected visual acuity,and postoperative complications.Results:Dual capsular tension ring placement was performed in 20 patients with a mean age of 48.7 years.The cyclodialysis cleft extended over 2.9 clock hours(range 0.5-6.5).The modified capsular tension ring was successfully inserted into the ciliary sulcus and a capsular tension ring or modified capsular tension ring in the capsular bag in all eyes.At the last follow-up,the cyclodialysis cleft was closed in 16/20(80.0%)eyes.The intraocular lens was stable in all patients postoperatively.Best-corrected visual acuity,in terms of the logarithm of the minimal angle of resolution,improved from 1.3±0.8 before surgery to 0.4±0.3 after surgery(P<0.001).Intraocular pressure increased significantly from 10.6±3.2 mmHg before surgery to 13.0±4.8 mmHg after surgery(P=0.040).Postoperative complications included a painful reversible intraocular pressure spike in four patients(20.0%).Logistic regression revealed no significant factors associated with successful cleft closure and a stable final intraocular pressure of≥10 mmHg.Conclusions:The placement of two capsular tension rings into the ciliary sulcus and the capsular bag is a safe,successful procedure combined for repairing a traumatic cyclodialysis cleft and managing zonular dialysis.展开更多
Background:To evaluate the efficacy and safety of placing dual capsular tension rings for the combined management of traumatic cyclodialysis cleft and zonular dialysis.Methods:A modified capsular tension ring was inse...Background:To evaluate the efficacy and safety of placing dual capsular tension rings for the combined management of traumatic cyclodialysis cleft and zonular dialysis.Methods:A modified capsular tension ring was inserted into the ciliary sulcus and a capsular tension ring or modified capsular tension ring was inserted into the capsular bag in 20 eyes in 20 consecutive patients showing signs of ocular hypotony and ectopia lentis.Outcome measures included intraocular pressure,best-corrected visual acuity,and postoperative complications.Results:Dual capsular tension ring placement was performed in 20 patients with a mean age of 48.7 years.The cyclodialysis cleft extended over 2.9 clock hours(range 0.5-6.5).The modified capsular tension ring was successfully inserted into the ciliary sulcus and a capsular tension ring or modified capsular tension ring in the capsular bag in all eyes.At the last follow-up,the cyclodialysis cleft was closed in 16/20(80.0%)eyes.The intraocular lens was stable in all patients postoperatively.Best-corrected visual acuity,in terms of the logarithm of the minimal angle of resolution,improved from 1.3±0.8 before surgery to 0.4±0.3 after surgery(P<0.001).Intraocular pressure increased significantly from 10.6±3.2 mmHg before surgery to 13.0±4.8 mmHg after surgery(P=0.040).Postoperative complications included a painful reversible intraocular pressure spike in four patients(20.0%).Logistic regression revealed no significant factors associated with successful cleft closure and a stable final intraocular pressure of≥10 mmHg.Conclusions:The placement of two capsular tension rings into the ciliary sulcus and the capsular bag is a safe,successful procedure combined for repairing a traumatic cyclodialysis cleft and managing zonular dialysis.展开更多
AIM: To investigate the frequency of idiopathic phacodonesis (IP) in senile cataract subjects and the short-term clinical outcomes following cataract surgery. METHODS: This institutional case-control study included 13...AIM: To investigate the frequency of idiopathic phacodonesis (IP) in senile cataract subjects and the short-term clinical outcomes following cataract surgery. METHODS: This institutional case-control study included 1301 consecutive low-income cataract subjects from June to November 2009. Anterior segment were carefully evaluated with dilated pupil under slit-lamp. IP were screened and graded by a criteria set by the authors. Risk factors, surgical outcomes, and operative complications were analyzed. RESULTS:A total of 42 subjects (3.2%) with IP were diagnosed and classified as grade 1 (36 subjects), grade 2 (5 subjects) and grade 3 (1 subject). Harder lenses and intumescent cataracts were observed in the IP group than the control group (P <0.05). Logistics regression test also indicated the main risk factor was the hardness of the lens. The incidence of zonular dialysis during surgery was 23.8% (10 eyes), which was significantly higher than the controls (0.7%, ( P<0.001). Visual outcomes of the two groups were not statistically or clinically significant. CONCLUSION: Hard nucleus and intumescent cataract are related to IP in senile cataract subjects in Qinghai, China. With more care being taken, grade 1 and some of the grade 2 IP subjects achieved similar surgical outcomes as compared to controls.展开更多
BACKGROUND The retrospective review of I-ring pupil expansion ring use is designed to examine the patient characteristics and associated surgical challenges in a clinical practice.The hypothesis is that I-ring provide...BACKGROUND The retrospective review of I-ring pupil expansion ring use is designed to examine the patient characteristics and associated surgical challenges in a clinical practice.The hypothesis is that I-ring provides a necessary additive tool in dealing with challenging cataract surgeries with small pupils.AIM To document the safety profile and use of I-ring pupil expansion ring in a clinical practice.METHODS A retrospective chart review of 12 consecutive cases within the same year(2016)of cataract surgeries employing I-ring pupil expansion ring(Beaver-Visitec,International)by a single surgeon at the same ambulatory surgical center was conducted.Demographic,pre-op,intra-op,and post-op data were recorded.Total number of cataract cases performed was also recorded.RESULTS 8 of 12 cases were planned I-ring cases.1 case was decided intraoperatively when femtosecond laser caused the pupil to shrink.The other 3 cases were also decided upon intraoperatively when pupil was deemed to be small.7 patients had IFIS from Flomax use.2 patients had pseudoexfoliation syndrome as the cause of small pupil.2 patients had narrow angles with brunescent cataracts.2 patients had pre-op partial zonular dehiscence.1 patient had 360o of posterior synechiae.2 cases had ruptured posterior capsule that required anterior vitrectomy.No complications were attributed to the pupil expansion ring.A total of 296 cataract surgeries were performed that year by the surgeon,making the rate of pupil ring use 4.1%.CONCLUSION Small pupil requiring pupil expansion ring during cataract surgery is often associated with other challenges,such as brunescent cataract,zonular weakness,and posterior synechiae in this series.I-ring helped to reduce at least one challenge in these difficult cases.展开更多
基金supported by the Project of National Natural Science Foundation of China(Grant no.82070943 and 82271068),Chinathe Shanghai Science and Technology Commission(Grant no.22Y11910400 and 23XD1420500),China+3 种基金Program for Professor of Special Appointment(Eastern Scholar,TP2022046)at Shanghai Institutions of Higher Learning,ChinaMedical Engineering fund of Fudan University(yg2023-26),ChinaFund of Fudan University and Cao’ejiang Basic Research(24FCA16),ChinaShanghai Anticancer Association EYAS PROJECT(SACA-CY22C03),China.
文摘Ectopia lentis(EL),characterised by impaired zonular fibers originating from non-pigmented ciliary epithelial cells(NPCEC),presents formidable surgical complexities and potential risks of visual impairment.Cataract surgery is the only treatment method for EL,but it leads to the loss of accommodative power of the lens post-operatively.Furthermore,the challenge of repairing zonular ligaments in situ remains a significant global issue.Ocular tissue and aqueous humour samples from patients with EL were subjected to RNA sequencing and Olink high-throughput proteomic analysis,revealing the downregulation of pathogenic genes(FBN1,MFAP2)and upregulation of secretory proteins(IL-12,MMP-1).The high expression of FBN1 and MFAP2 in NPCECs suggests their potential as candidates for zonular fiber construction;however,the limited availability of donor sources restricts the feasibility of NPCEC transplantation therapy.The reprogramming and directional differentiation of induced pluripotent stem cells(iPSC)to NPCEC was successfully achieved using the developed biomimetic scaffolds that mimic the microstructures of natural radial zonular fibers.Excitingly,the single injection of induced NPCEC-like cells significantly contributed to restoring and enhancing mechanical properties in zonular fiber structures in a rabbit model with EL.This proposed in situ iPSC-based regeneration technique might serve as an innovative therapeutic strategy for clinical EL patients,reduce the cataract surgery rate,and retain the adjustment capacity of inherent lentis.
基金This work was supported by the National Natural Science Foundation of China(grant no.81770908)the National Key R&D Program of China(2018YFC0116000)the Shanghai Science and Technology Commission(18411965200).
文摘Background:To evaluate the efficacy and safety of placing dual capsular tension rings for the combined management of traumatic cyclodialysis cleft and zonular dialysis.Methods:A modified capsular tension ring was inserted into the ciliary sulcus and a capsular tension ring or modified capsular tension ring was inserted into the capsular bag in 20 eyes in 20 consecutive patients showing signs of ocular hypotony and ectopia lentis.Outcome measures included intraocular pressure,best-corrected visual acuity,and postoperative complications.Results:Dual capsular tension ring placement was performed in 20 patients with a mean age of 48.7 years.The cyclodialysis cleft extended over 2.9 clock hours(range 0.5-6.5).The modified capsular tension ring was successfully inserted into the ciliary sulcus and a capsular tension ring or modified capsular tension ring in the capsular bag in all eyes.At the last follow-up,the cyclodialysis cleft was closed in 16/20(80.0%)eyes.The intraocular lens was stable in all patients postoperatively.Best-corrected visual acuity,in terms of the logarithm of the minimal angle of resolution,improved from 1.3±0.8 before surgery to 0.4±0.3 after surgery(P<0.001).Intraocular pressure increased significantly from 10.6±3.2 mmHg before surgery to 13.0±4.8 mmHg after surgery(P=0.040).Postoperative complications included a painful reversible intraocular pressure spike in four patients(20.0%).Logistic regression revealed no significant factors associated with successful cleft closure and a stable final intraocular pressure of≥10 mmHg.Conclusions:The placement of two capsular tension rings into the ciliary sulcus and the capsular bag is a safe,successful procedure combined for repairing a traumatic cyclodialysis cleft and managing zonular dialysis.
基金This work was supported by the National Natural Science Foundation of China(Grant No.81770908)the National Key R&DProgram of China(Grant No.2018YFC0116000)the Shanghai Science and Technology Commission(Grant No.18411965200).
文摘Background:To evaluate the efficacy and safety of placing dual capsular tension rings for the combined management of traumatic cyclodialysis cleft and zonular dialysis.Methods:A modified capsular tension ring was inserted into the ciliary sulcus and a capsular tension ring or modified capsular tension ring was inserted into the capsular bag in 20 eyes in 20 consecutive patients showing signs of ocular hypotony and ectopia lentis.Outcome measures included intraocular pressure,best-corrected visual acuity,and postoperative complications.Results:Dual capsular tension ring placement was performed in 20 patients with a mean age of 48.7 years.The cyclodialysis cleft extended over 2.9 clock hours(range 0.5-6.5).The modified capsular tension ring was successfully inserted into the ciliary sulcus and a capsular tension ring or modified capsular tension ring in the capsular bag in all eyes.At the last follow-up,the cyclodialysis cleft was closed in 16/20(80.0%)eyes.The intraocular lens was stable in all patients postoperatively.Best-corrected visual acuity,in terms of the logarithm of the minimal angle of resolution,improved from 1.3±0.8 before surgery to 0.4±0.3 after surgery(P<0.001).Intraocular pressure increased significantly from 10.6±3.2 mmHg before surgery to 13.0±4.8 mmHg after surgery(P=0.040).Postoperative complications included a painful reversible intraocular pressure spike in four patients(20.0%).Logistic regression revealed no significant factors associated with successful cleft closure and a stable final intraocular pressure of≥10 mmHg.Conclusions:The placement of two capsular tension rings into the ciliary sulcus and the capsular bag is a safe,successful procedure combined for repairing a traumatic cyclodialysis cleft and managing zonular dialysis.
基金Supported by Lifeline Express Hong Kong Foundation,China
文摘AIM: To investigate the frequency of idiopathic phacodonesis (IP) in senile cataract subjects and the short-term clinical outcomes following cataract surgery. METHODS: This institutional case-control study included 1301 consecutive low-income cataract subjects from June to November 2009. Anterior segment were carefully evaluated with dilated pupil under slit-lamp. IP were screened and graded by a criteria set by the authors. Risk factors, surgical outcomes, and operative complications were analyzed. RESULTS:A total of 42 subjects (3.2%) with IP were diagnosed and classified as grade 1 (36 subjects), grade 2 (5 subjects) and grade 3 (1 subject). Harder lenses and intumescent cataracts were observed in the IP group than the control group (P <0.05). Logistics regression test also indicated the main risk factor was the hardness of the lens. The incidence of zonular dialysis during surgery was 23.8% (10 eyes), which was significantly higher than the controls (0.7%, ( P<0.001). Visual outcomes of the two groups were not statistically or clinically significant. CONCLUSION: Hard nucleus and intumescent cataract are related to IP in senile cataract subjects in Qinghai, China. With more care being taken, grade 1 and some of the grade 2 IP subjects achieved similar surgical outcomes as compared to controls.
基金Supported by a research grant from Beaver-Visited International,the manufacturer of the I-ring
文摘BACKGROUND The retrospective review of I-ring pupil expansion ring use is designed to examine the patient characteristics and associated surgical challenges in a clinical practice.The hypothesis is that I-ring provides a necessary additive tool in dealing with challenging cataract surgeries with small pupils.AIM To document the safety profile and use of I-ring pupil expansion ring in a clinical practice.METHODS A retrospective chart review of 12 consecutive cases within the same year(2016)of cataract surgeries employing I-ring pupil expansion ring(Beaver-Visitec,International)by a single surgeon at the same ambulatory surgical center was conducted.Demographic,pre-op,intra-op,and post-op data were recorded.Total number of cataract cases performed was also recorded.RESULTS 8 of 12 cases were planned I-ring cases.1 case was decided intraoperatively when femtosecond laser caused the pupil to shrink.The other 3 cases were also decided upon intraoperatively when pupil was deemed to be small.7 patients had IFIS from Flomax use.2 patients had pseudoexfoliation syndrome as the cause of small pupil.2 patients had narrow angles with brunescent cataracts.2 patients had pre-op partial zonular dehiscence.1 patient had 360o of posterior synechiae.2 cases had ruptured posterior capsule that required anterior vitrectomy.No complications were attributed to the pupil expansion ring.A total of 296 cataract surgeries were performed that year by the surgeon,making the rate of pupil ring use 4.1%.CONCLUSION Small pupil requiring pupil expansion ring during cataract surgery is often associated with other challenges,such as brunescent cataract,zonular weakness,and posterior synechiae in this series.I-ring helped to reduce at least one challenge in these difficult cases.
